Native people face many barriers to medical care. Some are widely recognized, such as a lack of individual health insurance, or an absence of accessible, high-quality healthcare services. But other barriers are less obvious, as researchers with Partnerships for Native Health recently discovered.

For a study entitled “Culturally Adapted Strategies to Enhance Kidney Donation in Native Communities,” community health educators have been visiting Native patients on kidney dialysis to provide education and facilitation around the process of kidney transplantation. This study involves patients in urban and rural areas of two western states. Notably, Native people have high rates of chronic kidney disease and kidney dialysis, but low rates of kidney transplants. As our community educators have learned, several unforeseen barriers contribute to these low rates. All involve health system factors, and all might seem relatively simple or mundane – unless you happen to be a Native patient waiting for a new kidney.